Prescription drug database proposed

Bill sponsored by Senate President raises concerns over personal privacy

Posted: Sunday, February 17, 2008

By HAL SPENCEPeninsula Clarion

A measure now before the Alaska Senate would authorize the Board of Pharmacy to create and keep a detailed record of which Alaskans are using prescription drugs.

Senate Bill 196, sponsored by Senate President Lyda Green and a bipartisan group of lawmakers, seeks to establish a controlled substance prescription database in the pharmacy board that would include a record of every prescription written in the state for medicines controlled under state and federal law.

It could be ready for a floor vote Monday.

Sponsors say that physicians and pharmacists in other states where similar systems are used consider their databases critically important tools in prescribing and dispensing medications safely and quickly, and for alerting them to possible abusers.

But critics here and elsewhere in the country have raised concerns about security and suggest including such sensitive information in a database one available to doctors, pharmacists, law enforcement officials and others could be damaging to patients if their information ever fell into the wrong hands or became public, and may amount to an invasion of privacy.

Among other things, the database would include dates, physicians' names, patient names and their methods of payment, pharmacy information and "other relevant information as required by the board."

The central aim, say sponsors, is to help curb abuse of prescription drugs. Otherwise legal medications, including opiates used for pain control, rank second only to marijuana as a source of drug abuse in the U.S.

One practice databases might help curb, say supporters, is called "doctor hopping" seeing more than one physician in an effort to acquire multiple prescriptions. Surplus drugs are often then sold on the black market.

In the past decade, 40 states have launched drug-monitoring programs. Congress began appropriating funds to support a national Prescription Drug Monitoring Program in 2002, and in 2005, President George Bush signed a bill that included a $60 million grant program to help states cover costs in state programs.

Just how secure would Alaskan's medical information be in a state-run database? Sharon Legenza, with American Civil Liberties Union Alaska, suggests there are many questions needing answers.

"We have no official statement yet" about SB 196, Legenza said in an interview Thursday. "We are looking at the bill with obvious privacy concerns. We will want to see what occurs in committees."

Friday, SB 196 got a second reading on the Senate floor and could be brought up for a final vote as early as Monday. It would then be sent to the House.

Legenza said the ACLU would want to know how broad the bill's provisions are.

"Is it too inclusive? What exactly is the state agreeing to do for a grant?" she said. "I'd like to see how it stacks up to legislation around the nation."

Sen. Tom Wagoner, R-Kenai, said he was worried that the database might prove vulnerable to hackers. If they got access, they'd have direct knowledge of whose households were likely to contain desirable prescription drugs, he said.

Rep. Paul Seaton, R-Homer, also expressed concerns about misuse of the database, specifically about how an insurance company might use sensitive medical information.

"The concern would be that if people had prescriptions and the insurance company knew, the company could assume a precondition or make other decisions about insurability," he said.

That Alaskans' information might be shared with other states also gave him pause, Seaton said.

Senate Bill 196 includes provisions intended to keep information secure, but recognizes that misuse could occur. There are clauses making various abuses of the system either Class A misdemeanors or Class C felonies.

Another provision protects doctors and pharmacists from civil suits for accessing or failing to access the database.

The bill would grant legal access to personnel of the pharmacy board involved in licensing, board personnel or contractors as required for operations and review, doctors and pharmacists, as well as federal, state and local law enforcement authorities armed with search warrants, subpoenas, or court orders. Patients would have access to their own prescription records.

It would authorize the board to take disciplinary action against the license or registration of a pharmacy or pharmacist or physician for failing to submit information to the database.

Sponsors argue that built-in safeguards protect privacy and mirror those used in other states. In an interview Thursday, Ginger Blaisdell, a member of Sen. Green's staff who has worked on the legislation, hoped to ease public concerns about privacy by explaining how the database would be used and why SB 196 doesn't amount to an intrusion by big government.

"The easiest answer is that this information is already required and is already reported," she said. "Pharmacists have to provide information about dispensing practices for controlled substances to the DEA (federal Drug Enforcement Agency)."

The bill, she said, would simply make that information available through a state database so that physicians and pharmacists locally could employ it as a tool for treating patients.

According to Blaisdell, several of Alaska's emergency room doctors and the Alaska Pharmacists Association approached Sen. Green about sponsoring a measure that would help improve prescription handling.

Such databases in other states have garnered favorable support from medical personnel who say it allows them to make better pharmacological decisions for their patients, and act on tangible evidence instead of intuition when they suspect inappropriate activity, she said.

"Medical doctors say they would not give it up for the world," she said.

Under the proposed law, Pharmacy Board personnel would analyze the database looking for spikes in prescriptions and drug use that might indicate a problem. Not every spike would indicate criminality, however. For instance, Blaisdell suggested, small towns might have one level of use in the deep winter, and another at the height of the tourist season.

Alaskans may initially view SB 196 as an invasion of privacy, she said, because they are unfamiliar with the program and its benefits. Unfortunately, she added, just reading the bill won't answer every concern. Many of the finer points would be written later in regulations, not in statute, in order to allow rapid changes to procedures if necessary, Blaisdell said.

Just how big Alaska's problem with illegal prescription drugs is a matter of speculation; most illegitimate use likely goes undetected.

According to the Alaska State Trooper's 2006 Annual Drug Report, however, the Alaska Bureau of Alcohol and Drug Enforcement seized 521 "dosage units" (single pills) of hydrocodone, 1,589 of Oxycontin/Oxycodone, and 1,179 of "other prescription drugs" in 2006. That amounts to roughly one illegal pill for every 200 Alaskans.

Co-sponsoring the measure is Sen. Gary Stevens, R-Kodiak, who said medical professionals equipped with some certainty about what patients may already be taking, especially elderly patients who might not remember, would be far less likely to prescribe contraindicated medications drugs that could react badly in combination. In addition, it would alert medical personnel if someone were doctor hopping. But Stevens acknowledged there was a potential downside to database creation.

"It is a certain invasion of privacy," he said. "We are trying to write it so it isn't egregious."

The bill's strict confidentiality provisions, however, gave him confidence the information would be secure from "fishing expeditions" by authorities, he said.

According to the U.S. Department of Justice Web site, no monitoring program has ever reported a breach of confidentiality.

SB 196 could get a third reading and an up or down vote in the Senate on Monday.